SERENITYMIND CLINIC LLC
NPI 1811888407
Nurse Practitioner - Psychiatric/Mental Health in Cottage Grove, MN
About Serenitymind Clinic Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SERENITYMIND CLINIC LLC (NPI 1811888407) is a healthcare organization registered as a psychiatric/mental health in Cottage Grove, Minnesota and active in the NPI registry since July 2025. The organization lists Funsho King, Owner Of Entity, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Serenitymind Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Serenitymind Clinic LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Serenitymind Clinic LLC's NPI number?
The NPI number for Serenitymind Clinic LLC is 1811888407. It was assigned to this organization in the NPPES registry on July 11, 2025.
Where is Serenitymind Clinic LLC located?
Serenitymind Clinic LLC is located at 6818 91st St S, Cottage Grove, MN 55016. The listed phone number is (651) 237-3319.
What is Serenitymind Clinic LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Serenitymind Clinic LLC enrolled in Medicare?
Yes. Serenitymind Clinic LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Serenitymind Clinic LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Serenitymind Clinic LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Serenitymind Clinic LLC was last updated on July 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Serenitymind Clinic Llc · NPI 1811888407
Psychiatric/Mental Health organization in Cottage Grove, Minnesota. Organization record, active in the CMS NPPES registry since July 11, 2025.
## Identity
- **NPI:** 1811888407 (Entity type: Organization)
- **Enumerated:** July 11, 2025
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** No
- **Authorized official:** Funsho King, OWNER OF ENTITY
## Practice location
- **Address:** 6818 91ST ST S, Cottage Grove, MN 55016-4184
- **Phone:** (651) 237-3319
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 11, 2025
---
Source: [NPI Profile](https://npiprofile.com/npi/1811888407) · Data from the CMS NPPES public registry.